Cushing's syndrome

    Last updated date: 28-Aug-2023

    Originally Written in English

    Cushing's syndrome

    Cushing’s syndrome develops when the body produces too much cortisol hormone with time. This is a side effect of taking oral corticosteroids. Alternatively, the body may as well create too much cortisol. 

    A fatty hump located between the shoulders, a round face, and purple or pink stretch marks on the skin are some of the typical indications of Cushing’s syndrome caused by a lot of cortisol. On the other hand, Cushing’s syndrome can cause bone loss, high blood pressure, and type 2 diabetes for some people. Cushing’s syndrome treatments can help you regain control of the cortisol levels and relieve the symptoms. The sooner you begin treatment, the higher your chances of recovering.


    Signs and Symptoms of Cushing’s syndrome 

    Signs and Symptoms of Cushing’s syndrome

    Cushing’s syndrome signs and symptoms can vary based on the excess cortisol levels. The most common include the following; 

    • Gaining weight
    • Fat deposits, particularly in the middle section, face (resulting in a round and moon-shaped face), and between the upper back and shoulders, leading to a Cushing’s syndrome buffalo hump.
    • Development of purple stretch marks around the arms, breast, abdomen, or thighs
    • Skin thinning and easy bruising 
    • Injuries on the skin that take a long time to heal
    • Blemishes or acne
    • Exhaustion 
    • Weakness of the muscle


    Apart from the symptoms mentioned above, patients with Cushing's syndrome may experience other additional signs and symptoms. 

    These can include the following:

    • Increased thirst 
    • High blood pressure 
    • Osteoporosis 
    • Increased urge to urinate 
    • Hypertension or high blood pressure 
    • Anxiousness 
    • Headache 
    • Depression 
    • Mood swings 
    • Irritation 
    • Increased events of infections 


    Symptoms of Cushing’s syndrome in Children 

    Although less common compared to adults, children are also prone to Cushing’s syndrome. In addition to the symptoms mentioned above, Cushing’s syndrome is a child can be associated with the following; 

    • Slow growth rate 
    • Obesity
    • Hypertension (high blood pressure)


    Cushing’s syndrome in Females 

    Unlike men, Cushing’s syndrome is more common among women. According to studies, women are three times more likely to acquire the disease than men. Extra body and face hair can occur in women who have Cushing’s syndrome. 

    This is usually common on the face and the neck, the stomach, the chest, and the thighs. In addition, women suffering from Cushing's syndrome may have irregular menstrual cycles. On some occasions, menstruation is completely absent. Cushing's syndrome, if left untreated, can make it difficult for women to conceive. 


    Cushing’s syndrome in men 

    Just like the case of children and women, men who have Cushing’s syndrome can as well have other symptoms. They can include loss or decreased sexual interest, erectile dysfunction, and reduced fertility. 


    Cause of Cushing’s Syndrome

    Excess cortisol in the body is the cause of Cushing’s syndrome. Some of the underlying reasons for high levels of cortisol include; 


    The use of corticosteroid drugs, like prednisone, in higher doses over an extended period is the leading prevalent trigger of Cushing's syndrome. Doctors can administer these medications to treat inflammatory illnesses like lupus or to avoid the rejection of a donated organ.

    Cushing's syndrome can also occur due to higher doses of injectable steroids used to alleviate back pain. On the other hand, low-dose steroids in inhalants form, like those prescribed to treat asthma, or creams, like those used to treat eczema, are normally insufficient to cause the disease. 


    Pituitary tumors: Pituitary tumors cause eight out of ten Cushing's syndrome cases (except iatrogenic Cushing's syndrome). It’s characterized by too much production of ACTH (the hormone that signals the adrenal glands to create cortisol). This condition is known as Cushing's disease. 

    Tumors of the adrenal cortical: Cortisol production might be excessive due to a tumor on the adrenal gland. However, these are almost always harmless (benign tumors). 

    Tumors of the pancreas, lung, thymus, and thyroid: Ectopic ACTH syndrome occurs when tumors form outside the pituitary gland and release ACTH (adrenocorticotropic hormone). These tumors are almost always cancerous. Small cell lung cancer is the most prevalent kind of these malignancies.

    A primary adrenal gland disorder:

    This occurs when the adrenal glands release too much cortisol as a result of a malfunction. The most prevalent is an adrenal adenoma. It’s a noncancerous growth of the adrenal cortex that releases a lot of cortisol in a small percentage of adenomas cases. 

    Although cancerous growths of the adrenal cortex are uncommon, they can nonetheless lead to Cushing’s syndrome. On rare occasions, Cushing’s syndrome can occur from benign nodular enlargement of the adrenal glands. 

    Familial Cushing’s syndrome:

    This occurs from a rare inheritable tendency for people to get tumors on one or more endocrine glands. With this, this could impact the cortisol levels and result in Cushing’s syndrome.


    Cushing’s syndrome Diagnosis 

    If the doctor suspects that you have Cushing's syndrome, he or she will review your medical history. You will also be subjected to a physical exam and some laboratory tests or procedures. 

    Cushing's syndrome may be hard to identify at times. When someone complains of exhaustion and weight gain, it isn't necessarily a sign of Cushing's syndrome. Polycystic ovarian syndrome and metabolic syndrome are also common misdiagnoses. To rule out other diseases, your healthcare provider might have to go through an elimination process. 

    These diagnostic tests and procedures could help determine the problem if you have not been using corticosteroids: 

    Blood and urine testing: These tests assess hormone levels and determine if your body produces too much cortisol. The doctor can ask you to collect urine for 24 hours for this urine test. Both the blood and urine samples will be brought to the laboratory for further analysis. 

    Blood and urine testing

    Another specialized testing, which includes testing cortisol levels before and after the use of hormone drugs to boost or suppress cortisol, may be recommended. 

    Saliva tests: The levels of cortisol tend to rise and drop throughout the day. However, the levels fall dramatically in the evening in those who do not have Cushing’s syndrome. Doctors can determine whether cortisol levels are excessively high by testing cortisol levels in a small saliva sample obtained late at night. 

    Petrosal sinus sampling: This diagnostic test can assist in evaluating whether Cushing’s syndrome source is the pituitary gland or something else. Blood samples are obtained from the veins that drain the pituitary gland for this test. 

    Imaging tests: Doctors can alternatively use a CT scan or MRI to obtain images of the pituitary as well as the adrenal glands. This allows the detection of abnormalities like tumors.


    Crushing’s Syndrome Treatment 

    The form of treatment is determined by the source of the elevated cortisol levels. If you're on corticosteroids, your doctor will probably reduce your dose or suggest a non-corticosteroid prescription. If a tumor is the cause of Cushing's syndrome, it may need to be radiated or surgically removed.

    Alternatively, the medical provider can prescribe a cortisol-slowing drug like ketoconazole. To address the tumor and the symptoms of Cushing's syndrome, you may need to work with numerous healthcare experts. Cushing’s syndrome diet may also be recommended. 


    If a tumor is the source of Cushing’s syndrome, the doctor may suggest surgical removal. A neurosurgeon may operate on the nose to remove pituitary tumors. The surgeon can also remove a tumor in the adrenal glands, pancreas, or lungs via a regular operation or minimally invasive surgical procedures with tiny incisions. 

    Following surgery, you will be required to take cortisol replacement drugs to give the body an accurate amount of cortisol. In most situations, your adrenal hormone production will return to normal, and your doctor will be able to ease off the replacement medication. Blood tests will be used to decide if you require cortisol replacement and when to stop. 

    Radiation therapy:

    Radiation therapy

    In case the surgeons cannot completely remove the pituitary tumor, they are likely to recommend radiation therapy in addition to surgery. Radiation may also be useful for individuals who are not surgical candidates. 

    Small doses of radiation can be delivered within six weeks, or stereotactic radiosurgery can be used. The stereotactic radiosurgery approach offers a significant, one-time dosage of radiation to the tumor while minimizing radiation exposure to nearby tissues. 


    If a tumor is malignant and has metastasized to other areas of the body, chemotherapy is required. Make sure to talk with your medical provider about any side effects that might result from this treatment. 


    If surgery, radiation, or chemotherapy fails to suppress cortisol production, medications can be recommended. For people who have become very ill due to Cushing’s syndrome, medicines may be administered before a surgical operation to ease signs and symptoms and reduce surgical risk. Medical treatment may not fully alleviate all of the symptoms of too much cortisol.


    Complications of Cushing’s Syndrome 

    The complications of Cushing's syndrome that might result without the treatment include; 

    • Hypertension (high blood pressure)
    • Osteoporosis or bone loss that can occur in unusual fractures of the bones, including fractures of the feet bones and ribs fractures
    • Frequent and abnormal infections 
    • Type 2 diabetes 



    Cushing's syndrome is a challenging condition to live with. It leads to weariness, weakness, and hypertension, among other things.

    Chemotherapy, radiation therapy, and surgery are among the treatments that are at best inconvenient. They are, however, worthwhile since Cushing's syndrome is treatable with the appropriate treatment. Keep in touch with your doctor at every stage as well as before and after Cushing’s syndrome